2009 Patient Survey Results
At Perth & Scone Medical Group we have been conducting patient satisfaction surveys since 2003, and once again we are very pleased to see that the 2009 results remain consistently high. This is particularly pleasing from the point of view that our list is currently sitting around 12,850 patients with a resultant increasing demand on appointment availability for both doctors and nurses. We remain committed to providing high quality care to our patients and view this patient satisfaction survey as a tool to assist us with this aim.
We continue to use an adapted version of the recommended General Practice Assessment Survey (GPAS), and to ensure as wide a spread as possible, we handed out a total of 350 questionnaires during November 2008 (245 in Taymount 105 in Scone). We are very grateful to our patients for completing these questionnaires on an annual basis as the results do give us the opportunity to address areas where we may not be doing as well as we should.
As already mentioned above, the results have been consistently comparable over the 6 years and we again looked to gather feedback in relation to four prime objectives - access and availability, communication skills, continuity of care, and inter-personal attributes.
Access and Availability
Of the actual respondents who were willing to see any doctor, 95% said they were seen with 2 days (79% the same day, 10% the next day, and 6% within 2 days). When asked to rate this 91% said this was 'excellent', 'very good' or 'good'.
Of the actual respondents who wanted to see a particular doctor, 78% said they were seen within 2-3 days (41% the same day, 10% the next day, and 29% within 2-3 days). When asked to rate this 75% said this 'excellent', 'very good, or 'good'.
Of the actual respondents who were asked "if you need to see a GP urgently can you normally get seen the same day, 93% said YES.
Overall we were very pleased with these results and they once again confirmed the success of the robust management of our 'advanced access' appointment system to ensure overall capacity and demand figures remain at an optimum level. We also remain pleased that even with the use of our GP Registrar, Foundation Doctor, three GPs heavily involved in teaching and training, and female doctors who only work part-time, our figures for patients able to see their doctor of choice remain very high. This is despite the fact we are in the unique position of having two surgery sites with many of the doctors sharing their sessions between these sites. We feel justifiably proud, therefore, of our commitment to ensuring that we are offering enough doctor appointments to meet our current demand.
We continue to work extremely hard to ensure good access for patients in line with Government targets using a mixture of 'pre-bookable' and 'on the day' appointments. We have also increased the number of telephone consultations we offer and this has proved popular with patients who only require advice from the doctor. We remain concerned however, that as demand for health care continues to rise inexorably, and with an increasing patient list size, the capacity to respond to that demand will become more difficult.
We also remain concerned about the increasing number of patients who do not attend for their appointments, even when they have been given a 'on the day' appointment with their doctor of choice. We now operate a zero tolerance approach to this problem, and patients are sent a letter immediately advising them that if they continue to miss appointments they may be asked to leave our list.
We are committed though to constantly monitoring our appointment availability and continue to look at more innovative ways of providing good quality care.
As a longstanding Training Practice we have operated the recommended 10 minute appointments for many years now. The results showed once again that 94% of patients were seen within 20 minutes (13% less than 5 minutes, 55% 6-10 minutes, and 26% 11-20 minutes), although only 70% of respondents rated this highly.
There is no doubt that the doctors can struggle to complete all the tasks expected from a patient-centred consultation in 10 minutes, and they are very pleased that such a high percentage of patients are waiting no longer than 20 minutes. However, the doctors remain committed to ensuring each individual patient receives the appropriate care during the consultation despite time constraints.
When asked to rate how satisfied they were with our opening hours, 91% thought they were 'excellent', 'very good' or 'good'. This was an increase from our previous survey when 86% of respondents rated this highly. From individual comments made on the questionnaires last year, we introduced some earlier morning appointments and some later evening appointments and this has proved popular with patients.
Of the 343 respondents asked to rate their ability to get through to the practice on the phone, 83% thought this was 'excellent', 'very good' or 'good'.
Of the actual respondents (266) who had phoned to speak to a doctor on the phone, 82% rated this 'excellent', 'very good' or 'good'.
We were very pleased with these results as they confirm that our management of incoming calls, particularly in the busy morning period, is operating well. We have five incoming lines (3 to Taymount and 2 in Scone) available for patients only, and we ensure that there is always the appropriate number of staff available to cover the phones.
There is no doubt that there are certain times of the day, particularly when the phones open at 8.00 am, when there is an overwhelming amount of calls coming in, but staff are trained to manage these as quickly as possible. The fact that we have so many appointments available each day does help the staff to deal with each call quickly and efficiently. We continually monitor the situation though to try to improve the service where possible.
As noted in previous surveys, we pay particular attention to the interaction between our patients and staff. We are very much aware that general practice staff, in particular, will occupy a key position in influencing patients' perception of service quality.
We were once again delighted with the very positive results for our reception staff, where 99% of respondents rated them very highly (86% 'excellent' or 'very good' and 13% 'good'). The staff found these results very rewarding and they do reflect the hard work and commitment of the reception and administration staff in providing patients with a quality service.
The doctors continue to try to strike a balance between offering enough appointments to ensure easy access for patients, and allowing enough time within a consultation for patients and doctors to 'communicate'. All the doctors in the practice consider themselves to be approachable and friendly, with a commitment to involving patients in a 'partnership' approach to their medical care. It was very reassuring, therefore, to note the very high satisfaction ratings of 99% (87% 'excellent' or 'very good' and 12% 'good') with how thoroughly the doctor asked about symptoms, 99% (88% 'excellent' or 'very good' and 11% 'good) with how well the doctor listened to what was said, 98% (86% 'excellent' or 'very good' and 12% 'good) with how much the doctor involved the patient in discussions about care, and 99% (87% 'excellent' or 'very good' and 12% 'good') with how well the doctor explained the problem and any treatment needed.
Continuity of Care
We were pleased that once again the survey findings detailed above pointed to high satisfaction ratings of 78% of respondents able to see their doctor of choice either the same day, or within 2-3 days. When asked how often they see their actual doctor we again had high satisfaction ratings of 91% of respondents saying 'always' (12%), 'almost always' (33%), 'a lot of the time' (19%) and 'some of the time' (27%).
We are particularly pleased with these results when we consider that we have a Government access target of all patients being seen within 48 hours by a healthcare professional.
We do, of course, remain committed to a team approach to patient care and our computerised medical records and regular clinical meetings for doctors, nurses, and community nurses, ensures that the patients' medical records are fully updated at each contact to assist clinical staff who may see a patient if a colleague is unavailable, thereby ensuring continuity of care.
All our doctors are committed to encouraging patients to become fully involved in understanding and coping with their particular illness, so that they can make better decisions around treatment options for example. It was very pleasing, therefore, to note the very high satisfaction ratings of 97% with the time the doctor spends with a patient, 98% with the doctor's patience with questions and worries, and 97% with the doctor's caring and concern.
It was also encouraging to note that when asked if after seeing the doctor the patient felt able to understand their problem or illness, 85% said 'much more' or 'a little more', 82% felt able to cope with their problem or illness 'much more' or 'a little more', and 79% said they were able to keep themselves healthy 'much more' or 'a little more' than before the visit to the doctor.
It was interesting to note that our figures remained constant for the number of respondents seeing their doctor more than 3 times per year (74%). The number of respondents seeing their doctor more than 5 times per year also remained consistent at 42%, but these high levels do reflect very much the pivotal role general practice continues to have in dealing with chronic disease management.
If we add these figures to the number of patients seen by our Practice Nursing Team (5 nurses and 3 health care assistants), not surprisingly we have some cause for concern when future capacity and demand figures are considered.
Of particular satisfaction again to the whole practice team was the response to the satisfaction overall with the practice, with 90% saying they were 'completely' or 'very satisfied'. We consider ourselves to be a very 'patient centred' practice and these results confirm that our commitment to continuous quality improvement is proving to be a successful process.
CONCLUSION AND RECOMMENDATIONS
There was no doubt that the results from the patient survey were once again of a particularly high standard, with no individual area standing out as needing particular attention. However, as is usual with this type of exercise, it is often the qualitative statements that provide more meaningful points for potential action.
Our proposed action plan last year had only one area for potential action and that was to introduce some evening consulting sessions. We had agreed at that time to delay a decision on this until details of the anticipated extended hours DES were available. After studying the specification however, we were disappointed with the inflexibility offered by NHS Tayside for this DES. As previously noted we have two surgery sites, and to ensure that we meet the demand for appointments in both sites, and continue to offer a high standard of access during "normal" practice hours, does mean that the doctors are already working long hours.
To take on the extended hours DES as it stands would seriously compromise our access targets during the normal working day, but more importantly could have an effect on patient care. In our view this DES does not provide persuasive evidence for offering extending hours, other than for purely financial reasons, and at this point in time we have agreed not to participate.
Our survey results this year show that 91% of our patients are happy with our opening hours, but more particularly our results are very high for access to a doctor. From the more qualitative comments there were a total of 5 patients who said they would like more evening surgeries, and 3 who would like the surgery to be open at the weekend. Out of a total of 78 patients who gave comments, these results would appear to support our view that at this point in time we continue to maintain the status quo, but regularly monitor our demand and be alert to making changes as necessary.
As in previous years we will post a copy of this report on our website and give feedback to patients via a notice in the waiting room. We will also meet with a representative from P&K CHP to discuss the findings.
PROPOSED ACTION PLAN
While we were very pleased with the results from the survey, we are fully committed to providing high quality care to our patients and to looking at ways to improve the service. For this reason we have agreed some priorities for the next year and these are detailed below, including the people who will lead on these projects.
- Explore the issues for and against introducing a patient group to work with us to improve service delivery
Timescale: 6-12 months
Lead: Dr Jan Sinclair and Agnes Ramsay
- Audit our nurse-led chronic disease management clinics to get feedback on how useful patients find these
Timescale: 6-12 months
Lead: Dr David Shackles, Agnes Ramsay, Jacqui McNaughton
- Audit our current access standard in line with recent Government guidelines and using the collaborative model first introduced in 2005
Timescale: 6-9 months
Lead: Lyn Williamson, Agnes Ramsay
- View the full results of the survey (pdf) - includes the analysis given above, and charts showing the responses.